Replay-Minnesota Governor Hospital Association Debate (CC)

Mary Lahammer of TPT2 moderated a Governor candidate debate in front of the Minnesota Hospital Association at Madden’s Resort in Brainerd. Many of the exchanges between Democrat Mark Dayton, Republican Representative Tom Emmer and Independent Tom Horner had been heard before at earlier debates, but a couple nuggets stood out.

We learn that Representative Emmer doesn’t have a “lIving will” or a recent physical.

And Senator Dayton asserts, his budget really isn’t “2 billion down”, but “$890 Million”, and that would only be if he repaid the “$1.4 billon school shift”, which delays payments to schools, keeping it in the state coffers. Not as easy as it sounds, schools have had to go get loans to cover salaries and insurance.

0:00:01.739,0:00:05.660 Tom Emmer: The next Governor and the next Legislature will have almost 3 billion dollars more to spend so it’ll be closer to 33 billion dollars. We put out a budget that balances all areas of the state’s budget within the amount it has to spend 00:14

Mary Lahammer: But you need revenue. Where do you get revenue? 00:16

Tom Emmer: I’m sorry, the projection collections are going to be about 7 to 8% greater in the next biennium than they are now. 00:24

Mary Lahammer: Because you won’t be increasing any spending? 00:27

Tom Emmer: We are increasing spending in certain areas. For instance in Health and Human Services we’ve got about 650 billion – ah, million dollars more than the state’s current commitment in this biennium. So, some areas have been increased slightly and some areas have been decreased. But again at this point government has to live within its means. You can’t consistently talk about growing government when what you’re saying, you talk about more revenues. Let’s be honest. What we’re talking about is, where are you gonna raise taxes, Senator, where are you gonna raise taxes, Mr. Horner. You’re talking about 2.15 billion in new taxes in Mr. Horner’s proposal, you’re talking about billions in Senator Dayton’s proposal. What we’ve done is we’ve produced a budget that does not raise taxes at a time when Minnesota simply can’t afford to pay more taxes. And you know more importantly we’ve shown where our numbers are. Neither of these gentlemen, all they talk about is what they will protect, but not what they’re going to cut. And I think it’s time that we see those so people can get a good idea from all three. 01:26

Mary Lahammer: Can you cut more? Can you shift more? 01:30

Tom Emmer: Cut more or shift more? 01:31

Mary Lahammer: Yeah. 01:31

Tom Emmer: Mary, I’ve produced a balanced budget within the projected amounts that government’s gonna have. Government will be able to live within its means under an Emmer administration. 01:40

Mary Lahammer: So there’ll be no shifts? No budget shifts? 01:42

Tom Emmer: You do not have to shift, you don’t have to shift based on the budget we’ve given you. 01:44

Tom Horner: Sure. I mean, and I think it starts with an honest approach to the budget. I think we have to be transparent, I think we have to say to all Minnesotans, That we do have a 6 billion dollar shortfall left to us by Democrats and Republicans, who much like my colleagues here, approached the budget as a math problem to say “If we can make the numbers add up at the state level then we’re done with our job.” And I don’t believe that’s the case. I think that when you have a budget that says “We’re just going to transfer costs to the hospitals, to nursing homes, to assisted living facilities, to community based services,” that’s not an honest budget. And the reality is that you look around Minnesota. And 28% of care facilities, many of them in rural Minnesota, many of them attached to rural hospitals, are in financial peril. They’re on the the verge of closing 02:41

Mary Lahammer: And we’ll dive into that more 02:42

Tom Horner: Yeah, absolutely, I mean we need 02:44

Mary Lahammer: But how about your budget and revenue sources?

Tom Horner: So my budget 02:46

Mary Lahammer: Tell us about your revenue sources. 02:46

Tom Horner: Exactly right Mary. I mean my budget does have new revenue because we’re being left with a 6 billion dollar shortfall and simply to say that we can do it on the basis of what we did last year, is to say that the GAMC program, the the program that provides health care for the lowest income and most vulnerable Minnesotans is working. Because that’s exactly what the kind of budget you’re proposing for next year did to Minnesota and to hospitals and to nursing homes this year. 03:13

Mary Lahammer: You have you have revenue, you have sales taxes, cuts, cuts, cuts? Shifts? 03:16

Tom Horner: Right. So I would reform taxes by cutting ah taxes on the kinds of activities that discourage businesses from growing. So let’s put money into allowing businesses to invest in research, development, new technology, not to add to the bottom line but to invest in those kinds of activities that specifically grow jobs. Then we have to pay for it. And so I would lower the rate on the sales tax by 1%, and then expand it. Not to business to business services, not to essential services like health care 03:50

Mary Lahammer: Okay 03:51

Tom Horner: Medical services, but to expand it, and give everybody a stake in a more efficient government. 03:55

Mary Lahammer: Let’s talk about an issue that this crowd has a stake in, Health and Human Services. Senator Dayton, you mentioned 30% of the budget; seen as a weak economy drives more people into these state-run programs, like Medicaid and federal programs, how will you approach Representative Emmer, possible cuts to Health and Human Services? Is there anything that should not be cut that would be off limits within Health and Human Services in your budget? 04:20

Tom Emmer: Well this again is where we have been very clear Mary. We’ve put, we’ve not only held the current state commitment to Health and Human Services where it’s at but we’re increasing it by 650 million dollars in the next biennium. And we have said government not only has to live within its means but it’s gotta fund its priorities. And when we talk about Health and Human Services we’re talking about children, we’re talking about vulnerable adults, we’re talking about seniors, our nursing homes, those are where our priorities are. 04:49

Mary Lahammer: So it’s a priority that will not be cut? Nursing homes and seniors won’t be cut? 04:52

Tom Emmer: Again that’s if I were Governor it needs to be said this way. If I were Governor that would be, those would be the priorities that should not be cut. But we have put a specific number on the table. And understand that you have to work within the Legislative process. So once we get back if we are in the Governor’s office, we’ll be working with the Senate and with the House as to those details within that budget. Again, we produced all, in every area Mary, what government can do and live within. It’s gotta fund its priorities. It would be interesting to hear where these gentlemen are going to cut. You know Tom Horner talks about cutting almost 2 billion dollars but he hasn’t made it clear where. And it’s the same thing with Senator Dayton. I think people deserve to know all of the areas that these gentlemen are talking about trying to live within as well. 05:39

Mary Lahammer: Okay, let’s dive into 2 billion in cuts. Is that right? And where’s it gonna come from? 05:43

Tom Horner: Sure. I mean we are going to have to make cuts. And that’s not true Representative Emmer, and you know that. I mean I have made very specific proposals on how we’re going to cut the budget. We are going to start to transition away from some of the subsidy programs that aren’t working very effectively. Ethanol, JOBZ. Programs that really don’t create new opportunity don’t create new jobs, simply transfer jobs. 06:06

Mary Lahammer: How about Health and Human Services programs? 06:07

Tom Horner: I’ll talk about that very specifically how to better deliver human services through the counties. And a program that I have laid out that can save 4 to 500 million dollars while increasing the quality of the services and increasing the accountability of the services. So I have been very clear. But I’ve also been very clear to say “Look, you can’t just pretend that all of the folks who are delivering human services in hospitals, in the facilities, in community-based services, are going to be able to deliver the same quality of service at the same price that they did last year. Because the fact is everybody has costs that are going up. Costs that they can’t control. Insurance costs, energy costs, facility costs, and it is causing a problem. We do have 28% of nursing homes that are in financial peril. We do have a reimbursement systems that aren’t paying 06:59

Mary Lahammer: What’s off limits? 07:00

Tom Horner: hospitals even even their cost 07:01

Mary Lahammer: What’s off limits for cuts then? Are nursing home reimbursement rates? Are those off limits for cuts? 07:05

Tom Horner: I’ve put in, I’ve put in new money for older adult services because I think what we need to do Mary is not just to say, this is a math problem. It’s not just a matter of making the numbers add up. We have to start making the transition to a better kind of service. We have to invest in how we’re going to deliver services more effectively, more efficiently as our population gets older. 07:26

Mary Lahammer: Okay, Senator Dayton on Health and Human Services. Anything off limits for cuts? How are you going to deal with increased enrollment too in this economy? 07:32

Senator Dayton: Well Representative Emmer says off limits, and I would agree, should be older Americans, older Minnesotans, those with disabilities, that’s three fourths of medical assistance payments right there, and then we’ve just learned that now one-fourth of Minnesota’s children are being served by Medicaid. So you take children, older Minnesotans, and those with disabilities I mean you’re probably talking about 90% or more of the public expenditures under medical assistance, which is one of the reasons that the early opt-in for the federal medical, Medicaid funding is just crucial. Especially when we see now that those 08:09

Mary Lahammer: And we will dive into that, yes. 08:09

Mark Dayton: – we’ve seen that the rolls have gone up by fifty thousand. You know, we have a crisis in health care financing in this state, in this country. I would agree with Mr. Horner in the particular of the redesign team if I’m elected Governor that I would assemble right after the election and look at how we’re gonna finance healthcare. Because it’s you know it is the government side of things that is growing and one of the the driving forces of that is the cost for, the rising cost of private health insurance and the number of people who cannot afford health insurance. So they go to the public side. Or their employers are no longer making private health insurance available so they’re being forced to the public side. So it’s it’s you know oversimplifies and understates the scope of the of the real issue. It’s a much more holistic approach we need to take as a society 08:55

Mark Dayton: How are we gonna pay for health care? Well, I would agree, older Minnesotans,

Mary Lahammer: Does that mean nursing homes?

Mark Dayton: Yes.

Mary Lahammer: Reimbursement off limits for cuts? 09:02

Mark Dayton: We’ve driven nursing homes into bankruptcy in the state, we’re losing nursing homes that we have, we’re underpaying the ones that are still functioning and putting them in financial peril. And you know again we’re not reexamining how we’re paying for all these services

Mary Lahammer: Okay. 09:16

Mark Dayton: – so we’re just continuing to force people into underpayments and bankruptcy. 09:18

Mary Lahammer: Okay we’re going to transition into hospitals but I want to talk about health care real briefly and ask one of those surprise personal questions that I love to do. We should all get physicals every year, shouldn’t we? Who’s had their physical and gone to their doctor in the last year here? 09:33

Tom Horner: Within the last 12 months I have. 09:36

Mary Lahammer: Emmer? 09:37

Tom Emmer: I don’t, what did you ask me last Friday night? 09:40

Mary Lahammer: If you had a living will, which was no! 09:40

Tom Emmer: And I said no! 09:42

Mary Lahammer: Did you get a physical?

Tom Emmer: I don’t have a living will. I told her I got to take it one day at a time. 09:45

(Audience and Mary Lahammer laugh)

Tom Emmer: Have I had a physical? No, I haven’t had one in the last – but, I mean if you’re talking from a qualified physician no. 09:54

(Candidates, Lahammer, audience laughter throughout) 09:57

Mary Lahammer: I take it that means you had your physical? 10:00

Tom Emmer: You can take it any way you want! 10:02

Mark Dayton: I will cede my time to Mr. Horner – to Mr. Emmer to explore that further. 10:08

Tom Emmer: It felt like I’d been having a physical for awhile. (laughs)

Mary Lahammer: Alllll righty!! 10:18

Mark Dayton: Mary, have you?

Mary Lahammer: I have had my physical in the past year, thank you for asking. You’ve been dying to ask me question, too. 10:23

Mark Dayton: I know. Especially in front of your parents. 10:26

Mary Lahammer: Yes, thank you, my parents are proud to hear that. An issue that’s been in the news, the National Nurses Union and the Minnesota Nurses Association and advocating for mandated ratios of numbers of patients each nurse can care for. If Minnesota did so it would be the second state following California to do this. Tom Horner, as Governor if you were presented with a bill from the Legislature mandating nurse to patient ratios would you sign it? 10:53

Tom Horner: Well, and and I always try to avoid saying I would sign this bill or veto this bill. So let me say in general that I think that is an issue that is best decided by hospitals and their nurses based on their own population, their own community, and how they know best to care for their their patients. I think the evidence 11:09

Mary Lahammer: That sounds like a no, ‘cause you don’t have a maybe then. 11:11

Tom Horner: Well, I am trying to be very clear to say that as it is a matter of principle, I don’t think the state should be mandating staffing levels. Now, you know if a bill came in that did something else, maybe but no. I mean the state should not be mandating staffing levels because the evidence is very clear. In California where it has been tried that it has not improved quality of care. It has driven up costs. And and that there is compelling evidence. We have to be thoughtful about making sure that hospitals are able to adapt. And the reality is that with different kinds of care teams with different kinds of technology, hospitals more than anything else need flexibility in how they use their personnel. And so you look at Minnesota hospitals from border to border and we have the highest quality, 11:58

Mary Lahammer: Okay. 12:00

Tom Horner: – the best delivery of care in

Mary Lahammer: Okay, but let’s move on this one 12:04

Tom Horner: all of our hospitals. I think part of it is because of the flexibility 12:05

Mark Dayton: Well, I don’t give simple answers to complex questions. And as you know, since you know the process Mary, no Governor waits passively just to get a bill on his or her desk and then sign or veto. You negotiate in that process. I echo what Mr. Horner said. I volunteered three summers at the old Abbott Hospital. And you know I’ve been a consumer of hospital services myself, and one of my young interns was recently in a car accident, hit by a drunk driver, and was in two weeks of intensive care at Regions Hospital. I mean our hospitals in this state are superb. They’re one of the great resources we have. Here Brainerd and Bemidji Northeast are medical centers for north central Minnesota. I also have great respect for nurses. I made a sign that says you know “Doctors are important, nurses are essential.” And when my young intern was in Regions for 20, 24-hour intensive care, she had a one-on-one nursing ratio. And that was necessary, called for, and assume the hospital and the nurses agreed on that. 13:03

Mary Lahammer: So would you like to see 13:05

Mark Dayton: So

Mary Lahammer: Okay, okay 13:05

Mark Dayton I would like to see them negotiate and work out, I have put a lot of faith and trust in nurses, I think people do and the doctors and hospital administrators. Let’s negotiate something that’s in the best interest that allows some flexibility and also recognizes that nurses are saying “If we can’t provide the quality care that we know we must to our patients,” that they they’re in a position to know that it’s better or not better than anything else. 13:24

Mary Lahammer: So you won’t say yes or no. 13:25

Mark Dayton: I’ll say I’ll negotiate. 13:26

Mary Lahammer: Okay. Representative Emmer? Yes or no on a bill mandating 13:28

Tom Emmer: Mary first based on the information that we have from California, and studies all across the country as a matter of fact, that show that in fact it does not improve quality of care. And it drives up cost. I would never expect the Legislature to pass such a bill. But if it did somehow happen the answer would be no. I would not sign that. 13:49

Mary Lahammer: Not sign it. Very good, let’s move on to the next issue (audience applause for Emmer). Minnesota’s uninsured rate, along with the rest of the nation, ahs been climbing. One in 10 Minnesotans lack health insurance. And employer-provided coverage as we know is plummeting, across the country and right here in Minnesota. So Senator Dayton, you get this one first, how would you insure more Minnesotans get insurance? 14:13

Mark Dayton: Well, this would be part of the whole re-examination and your point, you know, it just came out, Minnesota’s rate has gone up, and we have one of the lowest rate of uninsured in the country. Because the Governor and the Legislature, unfortunately the Governor reversed it with GAMC, but there has been a recognition and my running mate Yvonne Prettner Solon has been instrumental in the Minnesota Senate in in expanding through GAMC, through MinnesotaCare, some of the alternatives to leaving people uninsured because we know that the uninsured go to emergency rooms and and out of necessity which is far more expensive than neighborhood clinics or the other kinds of appropriate medical care 14:49

Mary Lahammer: Would more people

Mark Dayton: So – it’s a

Mary Lahammer: – have insurance under a Dayton administration? 14:51

Mark Dayton: Well, that would be the goal, absolutely. We need to have affordable, accessible health care for all of our citizens. And because we know that if they don’t have affordable accessible care, they go somewhere where they get more expensive care at everybody else’s expense. That’s part of what drives up insurance. This is a circular issue here that we as a society, you know, really need to get on top of. Because you know we have an aging population, which we do, and we have a greater capacity to provide medical carewhich is a wonderful part of our modern life. These cost factors are driving, health care is now 17% of our GDP nationally, and we’ve got to rationalize and reform, and and but it’s got to be part of a whole approach. Because if the private sector, which in the past employer-provided health insurance was affordable, that system is unraveling. More and more people are going to these public needs, or they’re going somewhere where they’re gonna get service

Mary Lahammer: Okay 15:40

Mark Dayton: – so we have to get this as a holistic approach and not just say “Well, government, you’ve got only one piece of it.” It’s all part of the same. 15:46

Mary Lahammer: Okay, Representative Emmer, will more people have insurance under your administration, fewer people? It’s going away from employers. Should government provide it? Do you want everybody just in the private marketplace? 15:57

Tom Emmer: Yeah, I would prefer that, but there is a place for government in health care, obviously. 16:01

Mary Lahammer: What’s the place? 16:01

Tom Emmer: There are- there would be three things that I would say about this. First there’s a lot of uncertainty right now because of what’s happening in Washington. We don’t know what the status is going to be. There’s an election on the horizon, there’s been a commitment by a one party that they’re not going to support the federal health care legislation, creating uncertainty at the state level. But that being said, if we are elected Governor of the state of Minnesota, what we will be working with the Legislature on is first off trying to create more accessibility by creating more of a marketplace that will drive down costs. 16:35

Mary Lahammer: So more people will be insured? 16:37

Tom Emmer: Two things I’m gonna say about it, Mary first I think you’ve gotta decouple health care insurance from employment. You’ve gotta give individuals the same opportunities to deduct their health care insurance premiums that we right now give to employers. Second, you’ve got to give people more of an opportunity to pool with other individuals. And you’ve gotta give them an opportunity to make choices. Not only about who provides their health care insurance by shopping across state lines, but how they design the health care coverage that they have. That will start to drive down costs and then, if you really want to address all these problems, you gotta start growing jobs in the state of Minnesota again. You’ve got to give people the opportunity to make a quality living, and that is what in turn drives not only the programs 17:19

Mary Lahammer: Let me back up. Will that insure more people. 17:20

Tom Emmer: Absolutely! If they have a good job, they can not only put food on the table, clothes on their kids and pay their mortgage, but they can afford the great health care that we have to offer in the state of Minnesota. 17:30

Mary Lahammer: Okay, Tom Horner. 17:31

Tom Horner: Well, so let me speak –

Mary Lahammer: – How do you deal with the fewer people being insured and getting them into your program – 17:35

Tom Horner: So let me start with the answer to your question

Mary Lahammer: Thank you.

Tom Horner: – and then I’ll do the explanation

Mary Lahammer: Thank you! 17:38

Tom Horner: And the answer is, absolutely. In 2014 there will be more Minnesotans insured than there are today if I’m Governor. 17:45

Mary Lahammer: Okay. And how do you pay for it?

Tom Horner: I’ll tell you how.

Mary Lahammer: Yeah.

Tom Horner: And and it is an area where there is such a clear difference among the three of us. It is not simply by adding more government, and it is not simply by turning away from government. The reality is that in Minnesota, we’ve had a terrific private/public partnership. And I understand, as somebody who has purchased health insurance for my employees when I had the company. I understand the challenges of being a small employer, going out into the marketplace. And it’s not just having more insurance companies to shop from. That’s not what’s going to drive down costs! We have to make structural reforms. We have to do the kinds of things that we already have a good start on in Minnesota. Like, coordinating care for those with chronic illnesses. Like making sure that we’re paying for quality, not just outcomes. But a lot of those kinds of things, Mary, are going to take an investment upfront. We have to spend money to reform the system to make the transition to a better system. And you don’t do that if you just say “Government, go away” and you don’t do it if you just say “Dump more money into the existing program.” And so I understand as a small employer what happened when government comes along and says, “Well, we’re going to require insurance companies to cover this this and this,” my company pays for it. I understand what happens when you say to government, “We’re going to eliminate programs for the low income. We’re going to take GAMC again the program for the lowest income and dump ‘em on rural hospitals. 19:10

Mary Lahammer: Do you want to let people –

Tom Horner: Eventually I pay for it. And so here’s what I’m going to do. Is I will put money aside, have money in my budget, to do the early opt-in to Medicaid.

Mary Lahammer: Okay.

Tom Horner: I think we have to get more people covered in order to have reform. But then you have to build on it from there. You have to use the state’s purchasing power as the biggest purchaser of health insurance, of health coverage in Minnesota, to make redesigns in the system, to buy better. To create a different kind of marketplace. Not just with more insurance companies-

Mary Lahammer: How about

Tom Horner: -but fundamentally different.

Mary Lahammer: – should people be able to shop over state lines, like Representative Emmer says, do you want that, open it up to for-profit?

Tom Horner: It’s just not a solution.

Mary Lahammer: Okay. No? Okay.

Tom Horner: It’s not a solution. It’s political rhetoric. It hasn’t, you you don’t shop for health care in the same way that you shop for auto insurance.

Mary Lahammer: Okay.

Tom Horner: In auto insurance, you can get out your book and say “Dented fender, if you’re in Minnesota or

Mary Lahammer: Okay.

Tom Horner: – Illinois or Mississippi, here’s the cost.”

Mary Lahammer: Okay, you’ve –

Tom Horner: I have a heart problem, you don’t take out a blue book and say “here’s the cost of it.”

Mary Lahammer: Okay.

Tom Horner: You go to a public hospital, and I get examined personally. And that’s what we need. 20:10

Mary Lahammer: You mentioned federal health care reform, both of you have done that, that’s in the news right now too as some of the provisions start to take effect. Representative Emmer, is there any scenario where you would opt in? You know, Medicaid is a program that’s been around for almost half a century. Democrats and Republicans liked it, created it. Is there any scenario where the Chamber comes to you, the Hospital Association when they come to you and – and plead their case and you would opt in?

Tom Emmer: I think you always have to say you’ll listen. But you just named special interests as opposed to what’s good for all of Minnesota. And, I know there are a lot of folks from hospitals out here that are looking at this potential early opt-in money as the solution. What I just heard from my colleague next to me is, you know, we should continue down the road where our providers and our hospitals are getting reimbursed at lower than cost rates. We should be reimbursing at ten cents on the dollars, twenty cents on the dollar, thirty cents on the dollar. Mary, that is the wrong answer for the future. It’s not just based on the early opt-in right now

Mary Lahammer: But hospitals were cut in anticipation of this opt-in

Tom Emmer: If, if we could talk about the federal program and the play, what my position has been all along, is great. We do the early opt-in and then are we here in two years? Are we here in two years because the federal government is saying “Here’s your IOUs”? We talk about investing more money in health care but you know, here’s another IOU. Let’s talk about fixing this for the long term. Let’s start talking about at a state level. Not just pumping more money into it, let’s talk about the maintenance of effort requirements that come with the federal money

Mary Lahammer: Okay, you do some of these state reforms, then would you possibly be open to taking some federal money?

Tom Emmer: I think you always have to look at what the federal money is, that’s being offered and what it obligates us to in the long term. You never say no out of the gate, you always evaluate it based, you’ve got a fiduciary

Mary Lahammer: So you’re not saying no out of the gate?

Tom Emmer: I am to the early opt-in.

Mary Lahammer: Yeah.

Tom Emmer: I have and I always will. Because based on what I know right now it’s 430 million dollars over the first three years. It absolutely reimburses against what Minnesota prides itself on. Our system innovates. Why? Because we’ve figured out how to provide high quality at low cost. The federal reimbursement is based on volume of care. These are not the answers for the future of Minnesota. Besides, again, once we get to 2014 Mary, and I don’t know that anyone’s talking about it, eleven states were given the right to do the early opt-in. Two have elected it, only one has gotten it. As far as I know, they still don’t have their money. We gotta talk about long-term solutions instead of waiting for whatever it is we can get from the federal government

Mary Lahammer: Okay

Tom Emmer: – and then hoping that it carries us for a year.

Mary Lahammer: Senator Dayton, you came from the federal government as a U.S. Senator. The Fed money’s been kind of vilified. Is there a bad repercussion, does it tie the state’s hands, is the money really going to come through? 23:03

Mark Dayton: Well,

Mary Lahammer: Is it worth it to opt in?

Mark Dayton: In the, yes, because in the near term, the next three years, that means the 3.7 million dollars in additional funding for St. Joseph’s Hospital in Brainerd, almost 6 million dollars for a hospital in Bemidji, and these hospitals and especially in greater Minnesota have been pressed to the brink of financial insolvency, and that affects their ability to provide quality health care for all Minnesotans. And they’re also some of the mainstays of greater Minnesota’s economy. You know we’ve disagreed on this before, Representative Emmer, I went back and looked at the letter, the head of Minnesota Hospital Association and the Minnesota Medical Association wrote, urging Governor Pawlenty to sign the early opt-in and said the net cost to the state is 188 million dollars. It is in the budget projection for the next biennium. The money’s in there, 188 million dollars, for 1.4 billion in federal money. And you know I also want to point out they just came out yesterday with the announcement of the federal health care and the mandates. And I looked at them and I thought you know, here they’re requiring coverage for children under parents’ policies for up to age 26. Young people graduating from college these days, looking for jobs, are now going to be covered up until age 26 under their parents’ health care policies so they get health care. No co-pays for mammograms or colonoscopies, which we know are extremely important in preventing

Mary Lahammer: Okay.

Mark Dayton: – more costly health problems in the future. Prohibiting health insurance companies from exempting from failing to cover children because of pre-existing conditions.

Mary Lahammer: Yes.

Mark Dayton: Lifting the lifetime limit on what a health insurer will provide for somebody who has insurance and who has higher medical costs. Who – I mean I’d like to know if anybody disagrees

Tom Emmer: Absolutely. It’s, you know with all due respect that’s politicians again talking about “Isn’t this great? We’re going to provide all of this” and we all agree that it would be wonderful if we could. But are we writing checks that can never be cashed? Are we writing IOUs again that we cannot honor? That’s what we’re talking about here. We

Mary Lahammer: What about that preventative care, though, not denial of pre-existing conditions? Do you like those concepts? 25:11

Tom Emmer: Guaranteed issue we should absolutely support and we should have. But it’s the wrong approach. When we’re going to say government can solve all these problems. We need to start talking at a state level how we make sure that our hospitals can get credit for the uncompensated care that the law requires them to provide, rather than partnering up with a program that says you’re going to get reimbursed at an amount that’s actually below what it costs you to provide the care that you want to provide. 25:38

Mary Lahammer: A quick last word on 25:39

Tom Horner: Well, these are complicated issues. And again, I think that the real solution isn’t to argue about whether we have more government or less government, it is to have a discussion around how we keep building on what hospitals and nursing homes, providers, health systems already are doing in Minnesota. How do we provide better care at lower cost. And some of that is going to take an investment up front. So that we can save costs long term. That’s been our challenge in Minnesota. Is that for the last many years, when Representative Emmer has been in the Legislature, the approach has been shift the cost. Shift the cost to employers who are buying insurance, to individuals, to property taxpayers, and mostly to providers. And a budget that says “no growth” or a budget that says “let’s put in a lot of tax dollars.” is not a budget that’s going to do true reform. We need true reform, we have to be honest to say that if we’re going to have a robust health care market, if we’re going to have a strong rural community, a strong rural economy that has a health care infrastructure, we’d better to be willing to make investments right now so that we can have that long term good care, quality care, affordable care for the future. 26:52

Mary Lahammer: You mentioned long term care. Long-term care is what we’re going to turn to now. And we’re going to transition to another question about you and your personal lives. I think it’s the last one by the way. (laughs) We’ll start with you Tom Horner. Do you have long-term care insurance? 27:04

Tom Horner: No.

Mary Lahammer: Emmer, long-term care insurance? 27:06

Tom Emmer: No, I don’t have a living will, I haven’t had a physical, and no at this point (audience laughs) I don’t have long-term care insurance. 27:13

Mark Dayton: I do have a living will, I have had a physical and I do not have long term health insurance. 27:25

Mary Lahammer: Very good. Speaking of long term care, this is a type of care that’s extremely labor intensive. Census estimates that by 2030, Minnesota’s elder population will increase by over 100 percent. In that same time, caregiving workforce, is only said to increase by about 5%. So that’s a big gap. Again, this is a workforce that makes around 11 dollars an hour right now. So what policies do you have to recruit, retain qualified, dedicated caregivers for this booming population? Tom Horner. 27:57

Tom Horner: Well I think first of all you have to change the environment in which care is provided by creating more options, more opportunities. And so that means we have to look at how do we makes rue that people have the opportunity to age in place. And so there are some great programs around the state. In Steele County, Healthy Seniors. Uses a little bit of federal money, little bit of state money to build a consortium of non-profit agencies that help people age in place. Stay in their own home. 28:27

Mary Lahammer: And how does that help the workforce

Tom Horner: Well, because if we have fewer people who are in the facilities, we can put more money into staffing, we can put more money into care. You know, I don’t think, again, I don’t think it’s realistic to say that given the aging population, given the demands that we all have, that we’re going to be spending less money. In real terms, we are going to be spending more money. The challenge is, how do we spend it better? And I think we do have an opportunity, if we can find areas of efficiency where we can help people live independently for as long as possible, have a community-based system. If we can deal with chronic care, then, for those people who do need some institutional help, whether it’s assisted living, whether it’s a nursing home, then we have the resources where we can invest in quality care, including invest in the personnel. 29:22

Mary Lahammer: Okay. Representative Emmer, how about that personnel. We have boomers aging and it looks like the workforce is not going to be there to provide care. 29:29

Tom Emmer: – so you make it attractive. Second, I thought I just heard you said just the numbers themselves. We aren’t generating enough people to fill these slots in the future. I think, first when you talk about funding, I said it early, you have to fund your priorities. This should be one of our priorities. And contrary to what my colleague says, I voted for increasing the reimbursements to these great people in my time in the Legislature. Again, you gotta fund your priorities. You also gotta be honest about your budget. When you tell, when you try to be everything to everybody, and you tell em I produced this great budget, and we’re gonna fund K-12 education, we’re gonna fund health and human services, we’re gonna hold the line here, you’ve gotta start telling people where you’re gonna make up the two billion you’re missing or the two or three billion that you’re missing. Here’s what the ultimate solution to all of our problems is. One, government has to live within its means. Two, you’ve gotta fund your priorities. We’re not putting people out on the street. Three, you gotta start generating new jobs so that you can grow tax collections and pay for these things 30:36

Mary Lahammer: And how do you generate jobs in that workforce? This is a group that makes about 11 bucks an hour. What do you do to recruit, retain them? 30:41

Tom Emmer: I tell you, I just did. You drop taxes and you grow jobs in the private sector. And you fund your priorities. The more that you generate the more the opportunity to make investments in people’s health care.

Mary Lahammer: And that’s going to bring people into long term care?

Tom Emmer: I think there are a lot of people who are looking for opportunities right now. But where we’re at with our long-term care, the system is not supporting those opportunities the way it should. You need to focus on your priorities and I’ve already said, our seniors should be one of our priorities. 31:04

Mary Lahammer: Okay.

Tom Horner: Keeping in mind that many of these facilities are not for profit, the tax reductions might not be quite as impactful as they are in other industries. 31:12

Tom Emmer: So you have to talk about other ways of doing things. This should be that dialogue.

Tom Horner: Exactly. That’s exactly what I’m talking about.

Tom Emmer: Look, actually –

Tom Horner: In realistic terms.

Tom Emmer: Actually, you haven’t. You haven’t, Tom. You gotta talk about what you’re actually gonna do to these different organizations. You gotta talk about where’s that other two billion dollars. Where are you gonna cut it? I mean, where are the draconian cuts gonna come from? And your numbers don’t add up. You ARE gonna be taxing health services, you’re gonna put tax

Tom Horner: No I’m not!

Tom Emmer: – on people’s walkers, you have to in order to get to 2.15 billion. You gotta be honest about this. 31:41

Tom Horner: I am honest about it Representative. I started with Department of Revenue data

Mary Lahammer: Are you going

Tom Horner: I used their numbers.

Mary Lahammer: – to be taxing walkers?

Tom Horner: No, we’re not going to tax – (audience laughs)

Mark Dayton: I’m not taxing walkers

Tom Horner: I may ask Representative Emmer, I may ask Representative Emmer to kick in a few dollars eventually for his. But no, I mean I’ve said very clearly (audience laughs)

Tom Emmer: I’ve been kickin’ in a lot 32:00

Tom Horner: I’ve said very clearly we’re going to take medical services off the table, we won’t tax those, we won’t tax prescription drugs, medical devices, and the numbers do add up. The Department

Tom Emmer: They don’t. They don’t.

Tom Horner: The Department of Revenue said they did!

Tom Emmer: They have not,

Tom Horner: You have better –

Tom Emmer: – and you’ve gotta be honest about that.

Tom Horner: – you have better – I am honest about it.

Tom Emmer: No. It hasn’t been done.

Mary Lahammer: Okay, Senator Dayton.

Tom Horner: Wait a second! Wait Mary let me just finish.

Mary Lahammer: Very quickly. We do want to get Senator Dayton in.

Tom Horner: Well, I’m just curious as to where’s your information that the Department of Revenue has said my numbers don’t add up? Because the Department of Revenue told me that the numbers do add up. 32:30

Tom Emmer: Well, put it out there. We’ve asked, and we haven’t -

Tom Horner; I have put it out there!

Tom Emmer: – have not been given anything that supports that. In fact, what we have not been shown (cross talk)

Mary Lahammer: We’ll get there, but how about we’re on this fun tangent of numbers not adding up and your budget was criticized for not adding up 32:53

Mark Dayton: I don’t think, if anybody here is tracking whose numbers don’t add up, I would be surprised. Let me to back to the question. Because you know, I acknowledge, Representative Emmer has specified where he’s going to make draconian cuts. Twenty-one percent cut in health and human services. And when you talk about the fact that people in need to get paid 11 dollars an hour, and hopefully also have health care benefits themselves, and have job stability, and that’s one of the again key factors in the early Medicaid opt-in, 1.4 billion has been estimated by Families USA would mean 29,000 jobs added or saved in the healthcare sector of Minnesota. It’s crucial. So because this is a people-intensive business.

Mary Lahammer: Okay.

Mark Dayton: And so let me just say

Mary Lahammer: And if you have to find a billion more though in your budget

Mark Dayton: So more people, more people are going to cost more money. More people needing care. Now what we are doing in Minnesota, and we need to add to this, is the elderly waiver program. Minnesota’s one of the leaders in that in providing alternatives for this amount of care

Mary Lahammer: Are you peeking at my notes!? Because I’ll get there! 33:47

Mark Dayton: No, I’m not. I just –

Mary Lahammer: I promise! I promise! (laughs)

Mark Dayton: no, I’m not! Well, you have the advantage of the notes so I don’t know what’s next! But let me focus on – because some of the alternatives –

Mary Lahammer: I’ll let you get there. But – I’ll promise, I’ll let you get to elderly waiver, cause really I think you could have been peeking. They’re next. (laughs, audience laughs)

Mark Dayton: We’ll trade places here, how’s that?

Mary Lahammer: That physical must have been helping your eyes! (laughs)

Mark Dayton: I’m not going to get –

Mary Lahammer: How about your budget though? Are you going to have to cut into elderly services?

Mark Dayton: I have not cut, I have not cut in my budget. I have accepted the projections –

Mary Lahammer: But your new budget,

Mark Dayton: Same budget. Same one.

Mary Lahammer: – people have criticized as still being a billion short. Is it a billion short?

Mark Dayton: You know, it’s a work in process. I mean, I’ll look for additional cuts. The fallback position, I’ve said, which these two gentlemen have adopted, is to not repay the school shift, the 1.4 billion on the books, so if I had to, you know, worst case scenario, it’s 890 million that I’m short, you know, repay the 410, 510 million dollars in the shift and delay the other, that would be the worst case scenario. I don’t want to do that. I think that money is owed to the schools, it was taken from them involuntarily by the Governor in the last go-round, and that money is owed back, we have to square our fiscal accounts

Mary Lahammer: Okay.

Mark Dayton: – at the state level rather than putting the burden on local governments and as Mr. Horner said correctly

Mary Lahammer: Okay.

Mark Dayton: – on health care providers. 35:04

Mary Lahammer: Okay, Mr. X-Ray Vision (laughs) elderly waiver is the next topic. And it is a program (audience laughs) funded by state and federal dollars (laughs) that allows older adults who would otherwise be in a nursing home choose to be where they want to get that service. That can be in their home, assisted living, it seemed to be more cost effective. So tell us, how do you protect consumer choice when this waiver program has been cut in the last two legislative sessions. 35:31

Mark Dayton: Well, that’s the problem. I mean we’re we’re pennywise and pound-foolish. If we’re not supporting those that are showing a better alternative. Now Minnesota again we should take credit for what – the initiatives that you and others in this audience have taken in looking for lower-cost alternatives. It’s about $2200 a year less to provide an elderly waiver in home service, and many elderly would like to stay in their homes should be supported in doing so. That benefits them, that benefits the larger community. 35:56

Mary Lahammer: So, no more cuts to elderly waivers as has been done?

Mark Dayton: Well, no, because again, we’re we’re cutting off our nose to spite our face. We’re forcing the seniors, same thing with Pawlenty’s cutting the renter credit. The same thing with raising property taxes. Has happened under Governor Pawlenty’s so-called No New Taxes Mantra. Property taxes have gone from four billion to seven billion dollars statewide. That impacts seniors and their limited fixed incomes. And their ability to stay in their home. Cutting elderly waivers means they don’t have the support services to stay in their homes, stay in their apartment. And forces people into more costly forms of care. So you know I mean again if we just take a meat ax to one aspect of this unthinkingly, we’re just going to add costs on the other side of the equation. 36:38

Mary Lahammer: Okay. Representative Emmer, you were lucky to be a part of that Legislature that had to make cuts to elderly waivers. Would you continue to do that? 36:45

Tom Emmer: Mary, as I’ve already said, I’m the only one that’s put out a complete and balanced budget within the anticipated dollars that the state’s going to have. It includes a $650 million increase in health and human services. We’ll work through the legislative process if we are in the Governor’s office. And the Senate and the House and the Executive branch will all work on what that’s going to look like but here’s – 37:10

Mary Lahammer: But what about that concept though of being able to fund people staying in their homes and consumer choice?

Tom Emmer: You gotta fund your priorities,that should be one of our priorities. But again, you gotta go back to this, you know, the argument that somehow government should be allowed to expand, no matter what our economic situation is. It just isn’t the right approach. I don’t know how many people realize that general fund spending in this state from 2001 to the end of this biennium, 2011, will have grown by 6.5 billion dollars. What these two gentlemen are suggesting that in just the next 2 years, and I will say it again, without providing details, these two gentlemen are suggesting that in the next two years the general fund spending should go up by almost 8 billion dollars. So 6.5 billion in 10 years and almost 8 billion in the next 2 years, it’s simply not sustainable. We have put out a budget that maintains our state’s commitment and now we’ve gotta fund our priorities and this would be one of them. 38:05

Mary Lahammer: Is that true? Are you two looking at 8 billion dollar increases? 38:08

Mark Dayton: I would just point out, you know, you point the finger, Representative Emmer, at government, as though government’s creating these enterprises for its own benefit. It’s for the benefit of people. When 50,000 people in Minnesota have gone from private insurance or no insurance to these public systems, GAMC or MA in the last year, I mean, that government is then the repository of the failure of our, and we agree, job creation, but health care costs are one of the major impediments to job creation, so when the private employers are not insuring, when people lose their insurance, as you said, because they lose their jobs, and then they go to public assistance, which the point being made, if they didn’t do that they would be going uninsured to hospital emergency rooms, which would be even more costly for all the rest of us. You know, this is just not a matter of government running to increase its budget to expand its waistline. This is about real people, real crisis situations, and people desperate and turning to whatever they can to get the health care that – you know, it ought to be a basic right in this society with all of our resources. Do we need to find out how to do it better? Absolutely Mr. Emmer, I agree with you entirely. We need to take a look at how we reform our whole healthcare financing because this is going to be an expanding problem. People are getting older. I mean, more people in the elderly waiver programs? They’re not just you know appearing because they’re 15 years old! It’s because they’re 65, 75, 95 years old. Same thing with nursing homes, the pressures there. Let’s say these are real problems that are not subject to you know, rhetoric and just you know fingerpointing.

Mary Lahammer: Okay.

Mark Dayton: These are about helping people live out the rest of their lives with dignity and respect.

Mary Lahammer: Okay, let me help other –

Mark Dayton: – at an affordable cost.

Mary Lahammer: people get in on this issue.

Tom Horner: Well and I’m always pleased that Representative Emmer knows my budget better than I do. (audience laughs) And so I should allow him to talk about it. The fact is that the numbers have been validated by the Department of Revenue, and I think Representative Emmer knows that. Secondly that when you look at the six billion dollar shortfall, about half of it, roughly, is due directly to the decisions that Representative Emmer, Democrats, Republicans made in this past Legislative session. Just to kick the problems down the road. I mean, we’ve got to cover two billion dollars that came in from federal money to fund with one-time money ongoing operations. That has to either be real cuts or we’ve got to figure out how to pay it. The same thing with the school shifts. That’s the reality. And so to pretend that we can just tax a handful of people and everybody else in Minnesota gets a free ride, or we can just punish the poor, and everybody else gets a free ride, I think is not the right approach. I think on programs like elderly waiver, Mary, it is exactly the kind of investment that we ought to be making for the future. 40:49

Mary Lahammer: Sounds like no cuts, then to elderly waiver.

Tom Horner: But – but, absolutely.

Mary Lahammer: Okay.

Tom Horner: But we also need to be investing in other areas.

Mary Lahammer: Okay, let’s move on to other areas

Tom Horner: We need to make sure we have the transitions in other areas to get better value out of every health care dollar

Mary Lahammer: Okay

Tom Horner: – working with this community. 41:02

Mary Lahammer: Let’s tackle one more question before we get to wrap ups. There are multiple state and local agencies that potentially impact policy in Minnesota. Including, here’s just a small list: Board of Aging, Department of Human Services, Department of Health, 87 Counties, Minnesota Housing Finance Agency, Department of Commerce, we could go on and on. So, providers say this can be troublesome. It can prevent coordination, create duplication, makes it difficult for consumers and companies to navigate. So, Representative Emmer, Aging Services of Minnesota ahs been working on this issue. And what do you want to do to better align these state functions? You’ve talked a lot about redesign but what does that mean? 41:42

Tom Emmer: Well, it means eliminating all of these excessive number of windows that people have to go through in order to make things happen with government. And we’ve talked about

Mary Lahammer: Do some of these go away? Completely? 41:54

Tom Emmer: Well, they might. I mean we need to be talking about the fact that we have 86 counties and I think last time I counted 56 public health agencies. Do we need 56 public health agencies? We’ve got to talk about looking at every single agency as it exists. Where the overlapping jurisdiction is, where the overlapping authority is. And we need to streamline 42:17

Mary Lahammer: Did you cut a county, by the way?

Tom Emmer: What’s that? 42:18

Mary Lahammer: Did you cut a county?

Tom Emmer: I thought I said 87. 42:20

Mary Lahammer: Eighty-seven, yeah. (laughs)

Tom Emmer: Oh, did I? Did I say 86?

Mary Lahammer: Just wondering if that was one of the things you were going to cut in your budget! (laughs, audience laughs)

Tom Emmer: Hey! There are some people who would say yes. 42:28

Mary Lahammer: (laughs)

Tom Emmer: But you know I also want to go back Mary to one other thing. 42:31

Mary Lahammer: Yes.

Tom Emmer: Y’know, Senator I’m sorry if you took that as a pointing at you. That’s not what I was doing. The only direction I’m pointing it out in the future. And what you’re suggesting, with all due respect, what you’re both suggesting, y’know Tom, you point at the Senator and say you just want to tax some, and you talk about “I wanna tax everybody,” here’s the thing. That’s all we’ve BEEN doing. Here’s the thing. That’s all we’e been doing in this state now for decades. And you can’t just say “Raise more taxes and grow more government.” It’s not that government is a bad thing.

Mary Lahammer: Okay.

Tom Emmer: It’s that we’ve gotta

Mary Lahammer: We don’t want to run out of time.

Tom Emmer: – redesign it and we’ve gotta make sure that we don’t drive any more jobs away 43:01

Mary Lahammer: How about redesign, Senator Dayton, I’d like to hear on redesign and streamlining. 43:04

Mark Dayton: The overlapping of jursidictions, the duplication of reporting requirements, in fact hospitals have to deal with 12 different private insurers today on average. You know, all of this overlapping jurisdiction, if I could wave a magic wand, and I will tackle this if I’m Governor step by step with my runningmate Yvonne Prettner Solon, who has already started the process. Let’s eliminate a lot of these duplications and triplications. When I was in the Senate I offered an amendment, you know, I was told by the Mayo Clinic that Medicare rules and regulations comprises 510 pages. Now I took their word for it because I didn’t have time to read ‘em all myself. So I proposed an amendment saying that we ought to reduce the number of words by two-thirds, with the idea being that if it can’t be said in 37,000 pages, it doesn’t need to be said. 43:44

Mary Lahammer: (laughs) Okay..

Mark Dayton: And it was opposed, actually, by some of the interest groups.

Mary Lahammer: Okay.

Mark Dayton: But it just underscores the fact that these are again complex. But yes, the answer is we’ve got to reduce this overlapping jurisdiction and the multiplication of reporting requirements. 43:54

Mary Lahammer: Okay.

Tom Horner: Well, of course we do. I mean I would agree. But I’m the only one who’s actually put out specific proposals in how to do it, how to redesign the delivery of human services through the counties. Is it controversial? Yes. Is it going to take a new kind of tax system? Yes. I mean the problem, Representative Emmer, is also that we have a wrong tax system. We have a tax system created for a manufacturing and natural resources based economy as we’re moving toward a service and knowledge economy. And we better change our tax system. Not just by adding income taxes, but not by sticking our head in the sand and pretending that we can just continue the same path. We need to change the system. So along with a redesign, a very specific proposal that will take a lot of work. Will take the investment of everybody but we’ll get it done. We also need though to also give more trust, accountability and responsibility to our partners in the private sector. Including, we ought to say to nursing homes “We’re going to give you flexible licensing so you can figure out how to make sure that the beds in your facilities are used for the most cost-efficient effective purposes.” 44:57

Mary Lahammer: Okay, and speaking of those nursing homes and hospitals, we’ve been talking to a lot of folks here from those organizations. And there are many undecided voters in this audience right now. So make your final pitch. They’re on the fence. They’re not sure which you, which person they want to vote for. This is your final chance here. Tell them why you are the candidate for this crowd. Senator Dayton. 45:17

Mark Dayton: Well, I want to thank all of you from hospitals, nursing homes and health care providers in Minnesota. You’re one of the greatest resources that we have in our state. And literally, working as a volunteer orderly in a hospital in Minneapolis years ago, and seeing that the commitment of professionalism, doctors, nurses, and support staff and all of you, you’re one of the great strengths, platinum jewels of our social network in Minnesota. And when I was Commissioner of Economic Development I’d ask businesses “Why are you locating, why are you expanding in our state?,” always they said well-educated, hardworking productive citizens, and then one of the best health care systems in the world. I remember going to Amman, Jordan when I was in the U.S. Senate. And meeting with the foreign minister there. He asked me where I was from and I said “Minnesota.” I said “Do you know where Minnesota is?” He smiled and said “I spent 6 months there 3 years ago at the Mayo Clinic to save my father from cancer.” That’s the reputation Minnesota has that we want to build upon. So I thank you for what you’re doing and then say I know, as you do, that the political rhetoric aside, you’re facing cost crises, financial crises, and the challenges of providing quality medical care and and to an aging population and to a population where we could receive more services,

Mary Lahammer: Okay.

Mark Dayton: – and we need more services, and if I’m Governor I’ll work with you, WITH you, on how to do that more effectively. 46:39.

Mary Lahammer: Okay. Representative Emmer, why would you be the best Governor for hospitals and nursing homes? 42:42

Tom Emmer: Well I would too just echo, I’d like to say thank you, and I’d also like to say out loud, it is an honor and a privilege to be up here and running for this office with these two gentlemen. We have differences but I have a lot of respect for both. I will tell you, if somebody tries to suggest that the new way is raising taxes that a new direction, regardless of the tax policy that we apply, the new direction is just raising taxes and allowing government to grow yet again without addressing the structural reforms that have to happen, that is not the new direction. That’s the same direction supplied by well-meaning people in this state for decades now. It’s time to do it differently. It’s time for government to live within its means and start to grow jobs. ‘cause that’s what will pay for what we need. And why would we I believe provide the best representation? The best service to your organizations? Because I’m not willing to say that we can just keep band-aiding what we’re doing. We need to start talking about the reality. And this isn’t rhetoric. The reality that our providers are taking reimbursements at well below the cost of providing the service. We need to talk about at a state level how we can perhaps not only lead in Minnesota and in the region, but lead the country in terms of talking about reforms that will allow you to get full reimbursement, at least credit for it, maybe not with dollars but by being able to keep more of the revenues that you generate. More of the income you generate in providing the services. We need to talk about doing things differently and out of the box. Just because we’ve been doing ‘em Mary, this way for decades, well-meaning people in the early 70s thought they could make health care in Minnesota better. You know what? We’ve realized or we should have realized by now we’re headed in a direction that’s just making it harder and harder to do your job. Let’s start talking about the state taking a leadership role in helping you not only do the job that you want to do but get paid for it 48:34

Mary Lahammer: Okay. Finally, Tom Horner. 48:34

Tom Horner: Well, and I think that this debate has shown the clear differences so thank you very much for bringing us together. Thanks to all of us, all of my colleagues up here on the dais, because I think it does show the differences and the way Minnesota has to go. And we won’t solve our challenges, we won’t meet the needs of next year and the year after and many years to come if we just limit our solutions to this ideology or that ideology. Because the fact is we need to take good ideas whether they’re Republican or Democrat. And there are good ideas from all sides. We should incent private savings. We should incent the purchase of insurance. We should tell Minnesotans that you’re going to have to take more personal responsibility for your health care, including your long-term care. And we need to do it. But we also need to say as government, we will be partners with you in making a transition to a much more effective, efficient kind of system. And so, you’re right. We are going to have to get reimbursement up. Across the board. But we’re not going to do it if we say that government is going to be held to a level that isn’t going to meet the demand and we just have to be honest with that. So let me say this to you. Is that I think the next four years will take bold leadership. It will take innovative leadership. And bold leadership in the next four years only starts with bold leadership from you, the voters in November of this year. 50:00

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